Histologic Evaluation of Tibial Attachment in 11-Year Double-Bundle ACL Reconstruction with Hamstring Tendons: A Case Report

JBJS Case Connect. 2021 Apr 7;11(2). doi: 10.2106/JBJS.CC.20.00509.


Case: A 49-year-old woman injured her anterior cruciate ligament (ACL) as a high-school student. Double-bundle ACL reconstruction (DBACLR) using hamstring tendon grafts was performed because of recurrent instability. Eleven years after DBACLR, total knee arthroplasty was performed because of osteoarthritis progression. Histologic analysis was completed to observe the osteointegration of the tendon in the obtained proximal tibia. The tibial tunnel showed Sharpey-like fibers anteriorly, connecting the tendon graft and lamellar bone, whereas the intraarticular exit revealed well-aligned chondrocytes posteriorly, indicating chondral metaplasia of the tendon graft.

Conclusion: Tendon-bone healing can regenerate both fibrous insertion and chondral metaplasia in DBACLR.

Publication types

  • Case Reports

MeSH terms

  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Reconstruction*
  • Female
  • Hamstring Tendons* / transplantation
  • Humans
  • Middle Aged
  • Tendons / transplantation
  • Tibia / surgery